Provider Demographics
NPI:1518251107
Name:CHOULES, NICOLE (AUD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:CHOULES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N 1100 E
Mailing Address - Street 2:UNIT 29
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 N 1100 E
Practice Address - Street 2:UNIT 29
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-2608
Practice Address - Country:US
Practice Address - Phone:801-319-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7997609-4103231H00000X, 246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic